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HX641 34741 
RC311.1  .R91  Report  of  five  more 


RECAP 


REPORT  OF  FIVE  MORE  APPARENT 
CURES  OF  PULMONARY  TUBERCULO- 
SIS OCCURRING  IN  WORKING  PEOPLE 
WHO  WERE  TREATED  AT  A  DISPEN- 
SARY WITHOUT  INTERRUPTION  TO 
THEIR  WORK. 


BY 


JOHN  F.   RUSSELL,  M.D. 


NEW  YORK,  SEPTEMBER.  1906 


Columbia  Untoertfttp 

intljeCitpofltegark 

College  of  ipfjpgtciang  anb  burgeons 
iUfcrarp 


Digitized  by  the  Internet  Archive 

in  2010  with  funding  from 

Open  Knowledge  Commons 


http://www.archive.org/details/reportoffivemoreOOruss 


REPORT  OF  FIVE  MORE  APPARENT 
CURES  OF  PULMONARY  TUBERCULO- 
SIS OCCURRING  IN  WORKING  PEOPLE 
WHO  WERE  TREATED  AT  A  DISPEN- 
SARY WITHOUT  INTERRUPTION  TO 
THEIR  WORK. 


BY 


JOHN   F.   RUSSELL,  M.D. 


NEW  YORK,   SEPTEMBER,   1906 


"RC3/I.I 


AS  mentioned  in  a  recent  paper,  the  work  of  treating  self-sup- 
porting consumptive  working  people  is  being  carried  on  at 
my  rooms,  239  Thompson  Street,  two  doors  below  Fourth 
Street  (South  Washington  Square).  Physicians  are  cordially  in- 
vited to  send  suitable  patients  for  treatment  who  are  deserving  and 
who  are  able  and  willing  to  fulfill  all  the  requirements  for  membership 
in  the  class.  Patients  who  reside  elsewhere  than  in  the  Borough  of 
Manhattan  and  the  lower  Bronx  are  unable  to  obey  the  rule  requiring  all 
patients  to  report  at  the  rooms  twice  a  day  (no  exception  is  made  be- 
cause of  weather),  and  are  therefore  ineligible. 

The  object  of  this  and  previous  reports  is  to  show  that  uncom- 
plicated pulmonary  tuberculosis  occurring  in  working  people  is  cur- 
able in  the  home  climate  by  dispensary  methods,  without  inter- 
ruption to  their  work.  That  this  result  is  accomplished  by  careful 
attention  to  the  details  of  daily  life,  particularly  in  the  matter  of 
fresh  air  and  sunlight,  diet  and,  in  so  far  as  possible,  the  regulation 
of  exercise.     No  medicines,  except  cathartics,  are  employed. 

These  patients  are  working  people  and  must  continue  to  work 
while  under  treatment  in  order  to  obtain  means  of  livelihood.  This 
is  an  unchangeable  condition.  The  treatment  of  their  disease  is  ever 
secondary  to  the  struggle  for  subsistence.  How  to  obtain  the  great- 
est number  of  hours  of  fresh  air  and  sunlight,  what  to  eat,  when  to 
eat,  how  much  to  eat,  how  to  regulate  exercise  and  still  continue  to 
work,  must  be  determined  by  the  kind  of  work,  the  number  of  hours 
of  labor,  and  the  conditions  surrounding  the  patient  while  at  work. 

It  is  hoped  that  the  good  results  reported,  obtained  under  such 
manifest  disadvantages,  will  encourage  general  practitioners  every- 
where to  establish  dispensaries  similar  to  this  for  the  treatment  of 
patients  who  are  striving  under  like  conditions,  and  also,  to  treat  in 
private  practice  in  the  home  climate  those  to  whom  fortune  has  been 
more  kind,  but  who  cannot,  without  great  sacrifices,  seek  climatic 
or  sanatorium  treatment. 

To  treat  consumptive  working  people  in  a  dispensary  without 
interruption  to  their  work,  is  to  maintain  them  as  self-supporting; 
to  enable  them  to  keep  their  families  together  and  educate  their 
children;  to  teach  them  how  best  to  live  according  to  their  means; 
to  teach  the  precautions  necessary  in  their  relations  with  the  healthy, 
a  class  of  consumptives  who  can  be  reached  in  no  other  way. 


ANY  patient  with  uncomplicated  pulmonary  tuberculosis  in 
any  stage  of  the  disease  who  is  able  to  come  to  the  rooms 
twice  each  day  and  to  obtain  suitable  food,  shelter  and 
clothing,  is  accepted  for  treatment.  The  most  common  complications 
which  bar  treatment  by  this  plan  are  tuberculous  laryngitis,  old  cases 
of  emphysema  upon  which  tuberculosis  has  become  engrafted,  cardiac 
complications  and  cases  in  which  there  is  continued  high  tempera- 
ture with  or  without  repeated  profuse  hemorrhages.  Patients  of 
the  last-mentioned  type  require  rest  treatment.  About  all  the  patients 
have  more  or  less  hemorrhages  before  they  get  well,  but  in  ordinary 
cases  the  attacks  are  not  severe  enough  to  send  them  to  bed  for 
any  length  of  time  and  hence  do  not  interfere  seriously  with  the 
routine. 

All  patients  are  required  to  come  to  the  rooms  twice  each  day, 
in  the  morning  any  time  between  7  and  8.30  o'clock  and  in  the  even- 
ing between  7  and  8.30  o'clock.  At  such  times  they  drink  the  emul- 
sion of  mixed  fats  and  vegetable  juice  and  are  given  a  supply  of  ca- 
thartics and  calcium  chloride  mixture;  they  are  also  questioned  and 
advised.  Sunday  morning  patients  report  at  ten  o'clock  when  all 
are  stripped,  weighed  and  examined.  Women  are  weighed  in  their 
night  dresses. 

They  are  taught  to  sleep  in  a  sunny  room  if  possible  and  always 
with  windows  wide  open,  in  all  weather.  A  constant  supply  of  fresh, 
cold  air  is  insisted  upon.  Five-hour  intervals  between  meals  are 
arranged.  The  value  and  importance  of  cathartics  is  impressed 
upon  them.  Excepting  walking  in  moderation,  no  unavoidable 
exercises  are  allowed.  Exercises  which  include  movements  of  the 
arms  and  upper  part  of  the  body  undertaken  solely  as  exercise  and 
all  "breathing  exercises"  are  strictly  forbidden.  The  purpose  of  this 
rule  is  to  prevent  violent  or  forcible  expansion  of  the  thorax  and  pa- 
rietal pleurae,  which  must  drag  upon  adhesions  or  cause  additional 
friction  of  inflamed  surfaces.  This  consideration  is  quite  distinct 
from  that  which  forbids  exercise  of  any  kind  carried  to  the  point  of 
fatigue  because  fatigue  induces  fever.  Violent  arm  movements 
frequently  cause  exacerbation  of  the  disease  and  greatly  increase  ex- 
tent of  inflammation.  Because  these  patients  are  working  people 
it  occasionally  happens  that  a  patient's  occupation  is  of  such  a  char- 
acter that  undesirable  movements  of  the  arms  cannot  be  avoided 
during  labor.    The  rule  is  not  enforced  under  these  circumstances. 


They  are  taught  to  avoid  over-clothing,  particularly  of  the  chest, 
and  "chest  protectors/'  plasters  and  wraps  about  the  neck  are  for- 
bidden. Men  are  apt  to  wear  too  many  undershirts,  turn  up  their 
coat  collars  or  wear  special  neck  wraps.  Women  are  forbidden  to 
wear  corsets,  fur  tippets  and  coats  with  high  collars.  The  feet  are  to 
be  kept  dry  and  warm.  Overshoes  are  recommended  in  wet  weather. 
Places  of  amusement  are  to  be  avoided  and  if  possible  nine  hours 
sleep  obtained  at  night.  Alcohol  in  any  and  all  forms,  tea,  coffee, 
chocolate,  cocoa,  beef-tea,  broths,  beef-juice,  meat  extracts,  vinegar, 
are  forbidden.  Tobacco,  if  not  wholly  prohibited,  is  allowed  in  mod- 
eration. Soups  made  of  peas,  beans  and  vegetables  are  allowed. 
The  rules  are  strictly  enforced  and  patients  are  made  to  under- 
stand that  they  must  obey. 

The  foregoing  is  but  a  very  brief  review  of  the  treatment  and 
must  necessarily  be  so  in  such  a  report.  The  subject  is  covered  more 
fully  in  my  published  papers  and  I  shall  be  happy  to  send  these  to 
any  physician  who  wishes  further  information,  upon  his  request.  I 
desire  to  state  most  emphatically  that  these  papers  are  not  designed 
for,  and  should  not  be  placed  in  the  hands  of,  laymen.  Physicians 
are  also  invited  to  study  the  method  of  treatment  at  my  rooms. 

The  fats  of  the  emulsion  of  Mixed  Fats  are  made  up  of  equal 
parts  of  beef  fat,  cocoanut,  peanut  and  olive  oils  and  compose  about 
42  per  cent,  of  the  whole.  In  addition  there  are  about  three  drops 
of  clove  oil  to  each  ounce  of  emulsion. 

The  manufacturers  of  the  emulsion  have  experienced  the  greatest 
difficulty  in  securing  unadulterated  oils  of  good  quality.  This  does 
not  apply  to  beef  suet  and  cocoanut  oil,  but  is  true  of  peanut  and 
olive  oils.  It  is  always  difficult  to  detect  adulteration,  particularly 
in  the  case  of  olive  oil  when  mixed  with  high-grade  cottonseed  oil, 
and  in  many  instances  practically  impossible. 

Excellent  peanut  oil  is  now  obtained  from  abroad,  but  after  years 
of  experience  it  is  found  almost  impossible  to  secure  sweet  unadul- 
terated olive  oil.  These  uncertainties  and  difficulties  which  arise 
with  each  importation  of  olive  oil,  have  led  me  to  urge  the  manufac- 
turers to  employ  cottonseed  oil  of  high  finality  instead  of  olive  oil, 
because  this  oil  can  be  obtained  perfectly  pure  without  rancidity, 
and  because  I  have  determined  from  experiments  that  its  nutritional 
value  is  in  no  way  inferior  (<>  olive  oil. 

The  beginning  dose  of  emulsion  is  one-half  ounce  increased  every 

3 


three  days  by  one-half  ounce  until  two  ounces  are  taken  night  and 
morning.  The  emulsion  is  always  diluted  with  hot  water  and  drunk 
as  hot  as  possible.  The  dose  of  vegetable  juice  is  two  ounces  night  and 
morning. 

IN  arranging  diets  for  dispensary  patients  very  explicit  directions 
are  given  concerning  the  kind  and  quantity  of  a  few  articles  of 
food,  and  only  the  most  general  regarding  others.  There  are 
many  reasons  for  this,  but  chiefly  because  it  is  all-important 
that  the  patient  receive  sufficient  quantities  of  proteid  and  fat  and 
the  necessary  amounts  of  these  are  commonly  in  excess  of  appetite 
and  therefore,  not  eaten.  Foods  containing  these  constituents  in 
quantity,  particularly  if  combined,  are  also  expensive  and  not  numer- 
ous. Vegetables  on  the  other  hand  are  to  be  had  in  large  number, 
are  comparatively  inexpensive  and,  with  the  exception  of  wheat  and 
the  pulses,  usually  thought  of  as  sources  of  carbohydrates  and 
salts  alone. 

The  main  sources  of  proteid  are  raw  eggs,  milk,  bread  and  meat; 
of  fat;  raw  eggs,  milk,  butter  and  emulsion.  Excepting  corn  meal 
and  wheat  (as  bread),  no  directions  are  given  for  eating  cereals.  The 
pulses,  peas  and  beans,  are  recommended  in  the  form  of  soups,  but 
are  practically  ignored  in  estimating  the  amount  of  proteid  con- 
sumed, though  very  rich  in  this  constituent. 

Ordinarily  no  special  instructions  are  given  with  regard  to  the 
quantity  of  meat  except  to  limit  its  use  to  one  or  two  meals  a  day 
or  prohibit  its  use  altogether. 

Practically  then  specific  directions  for  the  consumption  of  a  daily 
amount  are  confined  to  the  following  foods,  viz. :  raw  eggs,  milk,  bread, 
butter,  emulsion,  vegetable  juice  and  occasionally  meat.  With  the 
exception  of  emulsion  and  vegetable  juice,  the  amounts  of  which 
remain  fixed,  the  daily  quantities  of  these  foods  are  determined  by  the 
gain  or  loss  of  weight  of  the  patient.  It  will,  therefore,  be  under- 
stood how  necessary  it  is  that  patients  should  be  weighed  regularly. 


THE  best  results  do  not  follow  when  all  the  above-mentioned 
articles  rich  in  proteid  and  fat   are  employed  in  the  same 
diet.     Certain  combinations  appear  to  act  better  than  others. 
For  example,  meat  and  raw  eggs  are  well  borne  and  so  likewise  are 


milk  and  bread  and  butter.  Meat,  raw  eggs  and  milk  are  not  well  borne. 
Milk  and  raw  eggs,  if  both  articles  are  given  in  quantity,  do  not  act  well. 
A  large  number  of  eggs  and  a  small  quantity  of  milk  may  be  taken  com- 
fortably for  a  long  time,  but  in  such  case  the  milk  is  insignificant  in 
amount.  Bread  and  butter  may  be  eaten  in  all  combinations,  but 
are  of  the  greatest  value  when  taken  in  quantity  with  milk  in  quantity. 
These  are  most  general  considerations.  No  rule  of  feeding  will 
apply  to  all  patients  or  to  the  same  patient,  under  all  circumstances. 
Patients  who  are  fond  of  milk,  bread  and  butter  invariably  gain 
rapidly. 

NO  change  is  made  in  diet  the  first  week  of  treatment  except  that 
all  receive  emulsion  and  vegetable  juice  and  abstain  from 
forbidden  articles  of  food.  Cathartics  are  freely  administered 
and  an  effort  made  to  thoroughly  clean  the  intestinal  tract.  If  the 
patient  has  been  taking  medicines,  these  are,  of  course,  discontinued. 
Patients  are  not  expected  to  gain  and  frequently  lose  weight 
the  first  week.  Beginning  with  the  second  week  the  particu- 
lar form  of  proteid  decided  upon  is  begun.  If  eggs,  the 
patient  is  directed  to  take  one  raw  egg  after  each  meal 
and  increase  this  number  by  one  egg  after  each  meal  every 
three  days.  The  total  number  of  eggs  prescribed  for  each  day  is 
estimated  by  the  progress  of  the  patient  in  weight  gaining.  The 
number  is  rarely  as  great  as,  never  more  than,  eighteen,  rarely  fewer 
than  nine.  If  the  patient  fails  to  gain  when  the  daily  number  of 
eggs  is  nine  great  care  should  be  taken  to  see  that  a  sufficient  quan- 
tity of  bread,  butter  and  vegetables,  particularly  the  former,  are 
consumed  before  increasing  the  number  of  eggs.  This  is  a  matter 
of  importance.  Many  patients  early  in  the  treatment  concentrate 
their  attention  upon  the  egg  portion  of  their  diet  and  are  apt  to  get 
the  impression  that  if  they  swallow  eggs  enough  very  little  if  any 
other  food  is  necessary  Lack  of  vigilance  in  this  regard  was 
one  of  my  early  mistakes.  Very  few  of  my  patients  now  take  eight- 
een eggs  a  day.  The  lessened  number  required  in  order  to  gain  is 
due  to  more  careful  teaching  in  the  matter  of  greater  quantities  and 
variety  of  the  foods  just  mentioned  and  the  addition  of  vegetable  juice. 
Patients  are  instructed  to  take  their  eggs  immediately  after  the  meal. 
They  are  allowed  to  swallow  them  without  milk  (yolk  unbroken), 
or  first  l>eat  them  with  milk,  whichever  way  is  preferred.  If  milk  is 
used,  the  daily  amount  advised  is  one  or  two  pints. 

5 


If  milk,  bread  and  butter  are  to  be  used  in  quantity,  meat  and 
eggs  are  gradually  stopped  and  milk  substituted.  One  pint  of  milk 
and  a  stated  quantity  of  bread  and  butter  are  directed  to  be  taken 
at  each  meal.  Vegetables  are  also  prescribed,  but  the  quantity  not 
specified.  One  pint  of  milk  (without  other  food)  midway  between 
breakfast  and  dinner  and  again  between  dinner  and  supper,  if  there 
is  failure  to  gain- without  it.  It  is  not  always  necessary  to  give  a  full 
pint  of  milk  between  meals.  The  amount  of  bread  and  butter  will, 
of  course,  vary  with  the  individual. 

It  would  greatly  simplify  treatment  if  accurate  rules,  prescribing 
the  daily  amounts  of  various  foods  necessary  in  order  to  gain  weight, 
could  be  formulated  from  the  body  weight  of  the  patient.  For  many 
reasons  this  is  obviously  impossible  in  the  case  of  invalids. 
The  requirements  of  a  healthy  individual  are  discussed  in  all 
physiologies.  The  requirements  of  a  diseased  individual  are  unknown 
and  must  be  determined  by  experiment  in  each  case.  I  shall 
venture,  however,  to  give  the  average  daily  amount  of  bread  and 
butter,  for  each  pound  of  body  weight,  consumed  by  ten  patients, 
while  undergoing  the  rest  treatment,  in  order  that  some  idea  may  be 
formed  of  the  amounts  necessary  to  gain  weight  under  these  circum- 
stances. It  should  be  remembered  that  the  patients  were  at  rest 
and  that  the  diet  during  the  rest  treatment  is  restricted  to  milk, 
bread,  butter,  emulsion  and  vegetable  juice.  This  differs  from  the 
diet  of  those  who  labor  and  who  are  not  allowed  eggs  and  animal 
flesh  only  in  that  less  milk  is  administered  and  no  vegetables.  The 
lung  lesions  in  these  ten  patients  were  various  and  in  several  in- 
stances far  advanced.  They  all  had  fever.  The  smallest  weight  was 
83  pounds  (woman),  the  greatest  135£  pounds  (man);  the  average 
115.8  pounds.  Treatment  lasted  eight  weeks.  The  smallest  gain 
was  10  pounds;  the  largest,  31  pounds;  the  average  19.3  pounds.  The 
smallest  average  daily  amount  of  bread  eaten  by  any  one  patient 
was  33  grains,  and  of  butter,  6  grains,  for  each  pound  of  body  weight; 
the  largest,  64  grains  of  bread  and  12.5  grains  of  butter.  The  daily 
average  of  the  ten  patients  was  45  grains  of  bread  and  8.7  grains  of 
butter  for  each  pound  of  body  weight. 

THERE  may  be  no  physical  signs  of  disease  of  the  chest  othei 
than  a  few  localized  rales  which  are  persistent.    No  appre- 
ciable abnormal  change  in  percussion,  breath  sounds,  voice 
and  fremitus.     In  addition,  tubercle  bacilli  may  not  be  found  in  the 

6 


sputum.  In  a  given  case  where  this  state  of  things  exists  it  should 
be  remembered  that  the  probabilities  of  the  case  being  one  of  tuber- 
culosis are  so  overwhelming  that  the  burden  rests  in  proving  the 
negative.  Treatment  should  be  begun  at  once  and  continued  until 
all  doubt  is  removed. 


PATIENTS  should  be  told  at  the  first  interview  that  treatment 
lasts  a  long  time  and  is  tedious  and  that  the  result  largely  depends 
upon  their  own  efforts;  upon  an  intelligent  and  persevering  practice 
of  the  rules. 

They  should,  therefore,  be  told  with  entire  candor  that  they  have 
consumption,  otherwise  they  cannot  be  made  to  appreciate  the  im- 
portance of  making  as  great  an  effort  as  is  required  in  most  cases. 
It  is  impossible  to  treat  patients  successfully  without  their  hearty 
co-operation.  Pulmonary  tuberculosis  is  curable  in  the  great 
majority  of  cases  by  systematic  treatment,  and  to  withhold  knowledge 
of  their  condition  from  these  sufferers  is  to  rob  them  of  the  spur  to 
effort  which  such  knowledge  inspires.  Patients  who  are  not  told 
the  truth  early  in  the  disease  usually  discover  it  themselves  before 
the  end,  often  too  late  for  treatment;  commonly  with  bitter  denun- 
ciation of  those  who  deceived  them. 


APPETITE     is    not    indispensable    for    successful    treatment. 
It   is    certainly    very    desirable,    but    not    necessary. 


UNLESS  patients  gain  weight  the  treatment  is  wrong  in  some 
particular.  There  are  instances  when  it  is  only  necessary  to  gain  a 
few  pounds,  but  increase  in  weight,  even  if  slight,  is  important  as  an 
indication  of  improved  nutrition. 

The  fact  that  a  patient  and  various  members  of  his  or  her  family 
have  always  been  under  weight  is  not  a  good  reason  for  failure  to 
gain.     All  patients  should  gain  weight. 

Continued  loss  of  weight  is  a  certain  indication  of  failure. 

Regular  weighing  (once  a  week  at  least)  is  absolutely  necessary 
if  the  treatment  is  to  be  carried  out  intelligently.  The  patient  should 
always  weigh  at  the  same  hour,  dressed  in  the  same  clothes  and  use 
the  same  scale. 

FRUIT  is  a    negligible   article    of    food.     There  is  no  obj< 
to  a  small    quantity  if   the    patient   desires.     Except   in   vegetable 
juice  it  is  never  prescribed. 

7 


THE  following  patients  came  under  my  care  before  I  stopped 
work  at  the  Post-Graduate  Hospital  Dispensary,  December  31, 
1905,  and  were,  therefore,  examined  by  the  committee  of 
inspection.  This  is  the  explanation,  also,  of  the  first  examination  of 
their  sputum  by  Prof.  H.  T.  Brooks,  the  bacteriologist  of  that 
institution : 

Case  LVI. — Harry  B e,  age  25  years;  single;  native  of  United 

States;  clerk  in  newspaper  office;  wages,  eighteen  dollars  a  week. 
Began  treatment  September  14,  1905. 

Patient  lives  alone  but  supports  an  invalid  mother  in  another 
city.  Total  income,  eighteen  dollars  a  week.  Works  at  night,  eight 
hours. 

Family  History. — Father,  aged  52  years,  mother  aged  40  years, 
two  brothers,  aged  23  and  21  years  respectively,  and  one  sister  aged 
26,  all  living  and,  with  the  exception  of  the  mother,  in  good  health. 

Personal  History. — Pneumonia  ten  years  ago.  Cough  began  three 
years  ago.  Expectoration  scanty.  No  hemoptysis  or  loss  of  flesh. 
Appetite  and  digestion  good.     Weight,  119£  pounds'. 

Examination  of  sputum  by  Professor  H.  T.  Brooks,  who  reports 
"occasional  tubercle  bacilli,  also  streptococci  and  staphylococci." 

October  17,  1905.  Examined  by  the  committee.  "Right  supra 
and  infra-spinous  scapular  region,  broncho-vesicular  breathing,  fine 
and  coarse  moist  rales." 

November    16,    1905.     Sputum   examined    by    Professor    H.    T. 

Brooks  who  reports  "sputum  of  Harry  B e  shows  no  tubercle 

bacilli." 

November  20,  1905  (by  the  committee).  "Chest  free  of  all  signs 
of  disease."  Time  under  treatment,  about  two  months.  Weight 
on  admission,  119^  pounds.  Weight  November  26, 1905,  126J  pounds. 
Total  gain,  7  pounds. 

Has  lost  no  time  from  work  during  treatment  because  of  illness. 

Diet  included  eggs  and  animal  flesh. 

8 


CASE  No.  LVI. 

The  following  cuts  show  location  and  superficial  extent  of  lesion: 


Case  LVII. — Hattie  G.  F r,  age  35  years;  married;  native  of 

United  States;  housewife.     Began  treatment  September  14,  1905. 

Family  consists  of  patient,  father,  mother,  husband  and  two  chil- 
dren.    Husband's  wages,  thirty-five  dollars  a  week. 

Family  History. — Father,  aged  72  years,  mother  aged  65  years, 
two  sisters,  ages  38  and  33  respectively,  living  and  in  good  health. 

Personal  History. — No  previous  serious  illnesses.  Cough  began 
about  fifteen  months  ago,  growing  worse  last  June.  Expectoration 
slight.  Hemoptysis  to-day  first  time,  pure  blood.  No  pain  or  night 
sweats.  Small  loss  of  flesh,  four  or  five  pounds.  Appetite  good. 
Sleeps  well.  Constipation.  Marked  loss  of  strength.  Weight,  109 
pounds. 

Examination  of  sputum  by  Professor  H.  T.  Brooks,  who  reports 
"rarely  tubercle  bacilli." 

October  16,  1905.  Examined  by  the  committee.  "Right  lung 
anteriorly,  from  clavicle  to  third  rib;  left  lung  anteriorly  to  second 
rib;  right  lung  posteriorly,  supra  and  infra  spinous  region;  broncho- 
vesicular  breathing,  fine  and  coarse  moist  rales." 

February  20,  1906.  Sputum  examined  and  reported  free  from 
tubercle  bacilli. 

April  4,  1906.  Sputum  again  examined  and  reported  free  of  tu- 
bercle bacilli. 

May  3,  1906.  Sputum  again  examined  and  reported  free  of  tu- 
bercle bacilli. 

This  patient's  lungs  no  longer  show  signs  of  disease.  Time  under 
treatment,  to  date  of  disappearance  of  tubercle  bacilli  from  sputum, 
a  little  more  than  five  months.  Weight  on  admission.  109  pounds. 
Weight,  May  13,  1906,  137£  pounds.    Total  gain  28£  pounds. 

Diet  included  eggs  and  animal  flesh. 

Lost  no  time  from  work  because  of  illness  while  under  treatment. 

This  patient  applied  for  treatment  because  of  pulmonary  hemor- 
rhage. 

10 


CASE  No.  LVII. 
The  following  cuts  show  location  and  superficial  extent  of  lesion: 


11 


Case  LVIII. — Ida  Z r,  age  35  years;  married;  native  of  United 

States;  ribbon  clipper;  wages,  five  dollars  a  week.  Began  treatment 
June  6,  1905. 

Family  consists  of  patient  and  three  children.  Total  income, 
five  dollars  a  week.  This  patient's  income  was  increased  by  charity. 
Work  is  done  at  home. 

Family  History. — Father  died  of  consumption  at  the  age  of  45, 
mother  died  of  consumption  at  the  age  of  40.  One  brother  aged  32 
and  one  sister  aged  38,  living  and  in  good  health. 

Personal  History. — Several  attacks  of  lumbago  in  the  past  three 
years.  Cough  began  May,  1904,  growing  worse  the  following  Decem- 
ber. Expectoration  moderate.  Hemoptysis  five  times  since  April. 
No  night  sweats.  Some  pain  in  left  mammary  region.  Loss  of  flesh, 
seven  or  eight  pounds.  Appetite  good.  Sleeps  fairly  well.  Not 
constipated.     Weight,  111  pounds. 

Examination  of  sputum  by  Professor  H.  T.  Brooks,  who  reports 
"numerous  tubercle  bacilli  and  innumerable  streptococci  and  staphy- 
lococci." 

June  29,  1905.  Examined  by  the  committee.  "Left  lung  an- 
teriorly from  clavicle  to  fourth  rib;  left  lung  posteriorly,  whole  scapular 
region,  broncho-vesicular  breathing,  fine  and  coarse  rales.  Right 
lung  posteriorly,  supra-spinous  scapular  region,  broncho-vesicular 
breathing,  fine  and  coarse  rales." 

February  22,  1906.  Sputum  examined  and  reported  free  of  tu- 
bercle bacilli. 

April  6,  1906.  Sputum  again  examined  and  reported  free  of  tu- 
bercle bacilli. 

May  3,  1906.  Sputum  again  examined  and  reported  free  of  tu- 
bercle bacilli. 

This  patient's  lungs  no  longer  show  signs  of  disease.  Time  under 
treatment,  to  date  of  disappearance  of  tubercle  bacilli  from  sputum, 
about  eight  and  a-half  months.  Weight  on  admission,  111  pounds. 
Weight  May  20,  1906,  132£  pounds.    Total  gain,  2\\  pounds. 

Lost  no  time  from  work  while  under  treatment  because  of  illness. 

Diet  included  eggs  and  animal  flesh. 

This  patient  applied  for  treatment  because  of  pulmonary  hemor- 
rhage. 

12 


CASE  No.  LVIII. 
The  following  cuts  show  location  and  superficial  extent  of  lesion: 


13 


Case   LIX. — Delia  K n,   age   37  years;  married;  native  of 

Ireland;  housewife.    Began  treatment  June  5,  1905. 

Family  consists  of  patient,  husband  and  one  child.  Husband's 
wages,  eighteen  dollars  a  week. 

Family  History. — Father  died  at  the  age  of  85  years.  Mother, 
aged  75,  three  brothers,  ages  ranging  from  50  to  33  years,  three 
sisters,  ages  ranging  from  42  to  28  years,  all  living  and  in  good  health. 

Personal  History. — Cough  began  last  January  with  an  attack  of 
pneumonia.  Expectoration  slight.  Hemoptysis  once  in  January 
and  again  yesterday.  No  night  sweats.  Pain  in  left  axillary  region. 
Loss  of  flesh,  22  pounds.  Appetite  poor.  Sleep  not  disturbed  by 
cough.  Not  constipated.  Marked  loss  of  strength.  Weight,  117 
pounds. 

Examination  of  sputum  by  Professor  H.  T.  Brooks,  who  reports 
"numerous  tubercle  bacilli  and  streptococci  and  staphylococci." 

June  29,  1905.  Examined  by  the  committee.  "Left  lung  ante- 
riorly from  clavicle  to  fourth  rib,  left  lung  posteriorly  supra  and  infra 
spinous  regions,  broncho-vesicular  breathing,  fine  and  coarse  moist 
rales." 

February  27,  1906.  Sputum  examined  and  reported  free  of  tu- 
bercle bacilli. 

April  4,  1906.  Sputum  again  examined  and  reported  free  of  tu- 
bercle bacilli. 

May  3,  1906.  Sputum  again  examined  and  reported  free  of  tu- 
bercle bacilli. 

This  patient's  lungs  no  longer  show  signs  of  disease.  Time  under 
treatment,  to  date  of  disappearance  of  tubercle  bacilli  from  sputum, 
nearly  nine  months.  Weight  on  admission,  117  pounds.  Weight 
May  20,  1906,  164  pounds.    Total  gain,  47  pounds. 

Lost  no  time  from  work  because  of  illness  while  under  treatment. 

Diet  included  eggs  and  animal  flesh. 

This  patient  applied  for  treatment  because  of  pulmonary  hemor- 
rhage. 

14 


CASE  No.  LIX. 

The  following  cuts  show  location  and  superficial  extent  of  lesioa: 


15 


Case  LX. — Elizabeth  E n,   age   19  years;  single;  native  of 

United  States;  dressmaker;  wages,  twelve  dollars  a  week.    Began 
treatment  April  13,  1904. 

Family  consists  of  patient,  mother,  sister  and  nephew.  Sister  is 
a  wage  earner.  Total  income  of  family,  twenty  dollars  a  week.  Work 
hours,  9  a.m.  to  6  p.m. 

Family  History. — Father  died  by  accident  at  the  age  of  36.  Mother, 
aged  46,  living  and  in  good  health.  One  brother,  aged  30,  suffers 
with  pulmonary  tuberculosis.  Two  brothers  died  in  infancy.  Two 
sisters,  aged  25  and  17  respectively,  living  and  in  good  health.  One 
sister  died  of  pulmonary  tuberculosis,  aged  22  years. 

Personal  History. — No  previous  serious  illnesses.  Cough  began 
six  months  ago,  growing  worse  three  weeks  ago,  when  there  was  an 
hemoptysis.  Blood-stained  sputum  for  one  week  succeeding  this 
attack.  Expectoration  slight.  No  pain  or  night  sweats.  Loss  of 
flesh,  about  four  pounds.  Appetite  poor.  Not  constipated.  Marked 
loss  of  strength^.     Weight,  123£  pounds. 

Examination  of  sputum  by  Professor  H.  T.  Brooks,  who  reports 
"small  number  of  tubercle  bacilli  and  numerous  streptococci  and 
staphylococci." 

April  28,  1904.  Examined  by  the  committee.  "Right  lung 
anteriorly  from  clavicle  to  third  rib;  right  lung  posteriorly,  supra 
and  infra  spinous  scapular  region,  bronchial  breathing  fine,  and 
coarse  moist  rales..  Left  lung  anteriorly  between  first  and  second 
ribs,  bronchial  breathing,  fine  and  coarse  moist  rales." 

Signs  of  disease  having  disappeared,  specimens  of  sputa  were 
examined  as  follows: 

February  28,  1906.     Specimen  reported  free  of  tubercle  bacilli. 

April  5,  1906.     Specimen  reported  free  of  tubercle  bacilli. 

May  4,  1906.     Specimen  reported  free  of  tubercle  bacilli. 

This  patient's  lungs  no  longer  show  signs  of  disease. 

Time  under  treatment,  to  date  of  disappearance  of  tubercle  bacilli 
from  sputum,  one  year  and  eleven  months.  Weight  on  admission, 
123J  pounds.  Weight  May  20,  1906,  140  pounds.  Total  gain, 
16|  pounds. 

With  the  exception  of  first  eight  weeks,  has  lost  no  time  from 
work  because  of  illness. 

Diet  for  one  year  included  eggs  and  animal  flesh.  Diet  for  four 
months  was  free  of  eggs  and  animal  flesh. 

This  patient  sought  treatment  because  of  pulmonary  hemorrhage. 

21  West  Eleventh  Street. 

16 


CASE  No.  LX. 

The  following  cuts  show  location  and  superficial  extent  of  lesion : 


17 


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